Diagnostic Procurement The Clinton Foundation HIV/AIDS Initiative

Transcription

1 Diagnostic Procurement The Clinton Foundation HIV/AIDS Initiative 28 October 2008 Geneva 1

2 CHAI Work in Diagnostics - Context Diagnostic Test Agreements - In 2002 when CHAI was formed, the price of many HIV/AIDsrelated diagnostics viewed as a barrier to scale-up of care and treatment programs in resource-limited settings - CHAI negotiated with diagnostic suppliers to bring down the cost of HIV/AIDS-related diagnostic instruments and tests - Diagnostic test agreements include HIV rapid tests, CD4, DNA PCR and viral load. - Chemistry and hematology negotiations are currently underway. 2

3 Operational Principles for Diagnostics Country tender process maintained Countries incorporate strategic sourcing practices* Payment backed up by LC s or other secure instruments Regular and aggregated orders Ongoing forecasting Use of international quality standard (WHO or other, as appropriate) Move towards multi-year tenders (3-5 years) Split bids per product, as appropriate Demonstration of secure distribution system and commitment to comply with international and national law (IPR) * These are explicitly specified in MOUs with purchasers in Procurement Consortium (with provision of order info) 3

4 CHAI s Role in Diagnostic Procurement In late 2006, CHAI was chosen as the implementing partner for UNITAID s pediatric program. UNITAID donation includes funding for ARVs, cotrimoxazole, diagnostics and nutritional supplements for children 15 years of age and under. In its role as implementing partner, CHAI began to procure HIV/AIDS-related diagnostics for the UNITAID beneficiary countries. 4

5 Pediatric Program: Beneficiary Countries Benefiting more than 100,000 HIVpositive children in more than 30 countries Angola Benin Botswana Burkina Faso Burundi Cambodia Cameroon China Cote d Ivoire Dominican Republic DR Congo Ethiopia Guyana India Jamaica Kenya Lesotho Liberia Malawi Mali Mozambique Namibia Nigeria OECS (6 countries) Papua New Guinea Rwanda Senegal South Africa Swaziland Tanzania Thailand Uganda Vietnam Zambia Zimbabwe 5

6 Pediatric Program: Diagnostic Commodities Available The following diagnostic test reagents and related non-commodity consumables are funded by the UNITAID pediatric program: HIV rapid tests for screening & diagnosis CD4 for staging & monitoring DNA PCR and RNA PCR for infant diagnosis Products procured are pre-approved by UNITAID on the basis of quality 6

7 Diagnostic Procurement Challenges Lack of standardization of products in-country, which results in procurement for a diverse number of platforms & products (reagents, controls & consumables) Due to short reagent shelf life, bulk purchasing is limited, resulting in more frequent orders of smaller quantities (or larger orders with staggered deliveries) and higher shipping costs Cold chain requirements for some items mean suppliers only ship early in the week, resulting in longer lead times Procurement of lab instrumentation requires long lead times for shipment, installation and training; multiple parties involved; communication/coordination required 7

8 Diagnostic Procurement Opportunities Negotiating long-term contracts with suppliers based on aggregated volumes, by-passing local distributors, can lower product costs but must be balanced again need for distributors where they are providing service/maintenance Long-term leasing arrangements with volume commitments can lower cost of test reagents For countries purchasing a high volume of consumables, can consider procuring these items directly from the manufacturer and bundling them in-country Improving supply chain and logistics management in-country (e.g., improved budgeting/forecasting) to keep freight costs down 8

9 One Diagnostic Procurement Opportunity: EID As part of UNITAID s pediatric initiative, CHAI advocated for UNITAID to provide funding for a comprehensive package of commodities needed to conduct DNA PCR testing for infant diagnosis: Reagent kits Associated laboratory consumables: pipette tips, tubes, etc. Consumables for Dried Blood Spot collection, storage & transport (blood tubes, DBS cards, dessicant, humidity cards, bags, etc.) Laboratory equipment where necessary UNITAID agreed to fund a turn-key solution for DNA PCR. The result was the design, procurement and delivery of various bundles of commodities for EID, which greatly simplified not only CHAI s procurement efforts, but also sample collection incountry. 9

10 Collection Supply Bundles for DNA PCR DBS Collection Bundles All products required for sample collection (e.g., filter paper, lancets, silica, gauze, etc.) are bundled into a small box, simplifying procurement and reducing supply chain risks Specifications and ratios determined through collaboration with Ministries of Health, clinicians, partner organizations, and Roche High- and Low-Prevalence Bundles available 10

11 Thank you 11